Women and Children First is pleased to note that The Lancet has launched a new series of papers which highlight the issue of preventable stillbirths.
An estimated 2.6 million stillbirths still happen annually. 98% of these occur in low and middle-income countries and 75% are in sub-Saharan Africa and south Asia. About 60% occur in rural areas and more than half in conflict and emergency zones, affecting the families who have least access to health-care. Half of all the stillbirths (1.3 million) occur during labour and birth. Some of these are due to congenital disorders, but the majority are due to preventable causes such as maternal infections and obstetric complications.
In 2014, the World Health Assembly endorsed a target of 12 or fewer stillbirths per 1000 births in every country by 2030. By 2015, 94 mainly high and middle-income countries had already met this target, although with noticeable disparities within countries, but at least 56 countries, particularly in Africa and in conflict-affected areas, will have to at least double their pace of progress to reach this target.
At present rates of progress, more than 160 years will pass before a pregnant woman in Africa has the same chance of her baby being born alive as a woman in a high-income country today.
Esther Sharma, Midwife and Women and Children First trustee writes about the impact of violence on pregnant and new mothers to mark the 16 days of activism against gender-based violence campaign.
It is well documented that gender-based violence cuts across all social, economic, religious and class boundaries. Violence against women and girls is described by the UNFPA as “one of the most prevalent human rights violations in the world”, affecting an estimated one in three women.
Gender-based violence may express itself in a host of harmful behaviours directed at women and girls, including sexual assault, female genital mutilation, rape (including marital rape), forced prostitution, early marriage, trafficking and any other acts of physical or psychological violence or even death. It is thought that violence against a women from her male spouse or partner (so-called intimate partner violence) is the most pervasive form of violence . However, gender-based violence is also rife in conflict zones, affecting women and girls “by virtue of nothing but their gender” .
Sadly, this violation of women and girls does not stop during pregnancy.
Women and Children First will soon begin work with the Welbodi Partnership in Sierra Leone to improve maternal and newborn health for 30,000 women and babies. This project was due to begin in 2014 but was delayed because it wasn’t possible to work with communities when people were not allowed to meet and were scared of contact with others in case they caught the virus.
This week saw the very welcome news that the WHO has declared Sierra Leone Ebola free so our plans can now be put into practice. However, the epidemic has had a huge impact on maternal health and leaves a legacy of increased teenage pregnancies.
A Report from the Liverpool School of Tropical Medicine, VSO and Water Aid highlights the maternal health problems caused by the biggest Ebola epidemic ever recorded which hit Sierra Leone, Guinea and Liberia in May 2014. By August 2015 there were 8,696 confirmed cases and 3,585 confirmed deaths in Sierra Leone alone.
The effect of the Ebola outbreak was not confined to individuals, but it also adversely affected public health services, particularly in maternal and newborn care. A significant number of health workers lost their lives and women were very wary of attending health facilities during the epidemic - even where services were still available. According to the Report, seven out of nine critical areas of maternity care were still provided but there were significant decreases in the numbers of women accessing antenatal and postnatal care and delivering in health centres. There was a 30% increase in maternal deaths and a 24% increase in newborn deaths.
Ebola was also most likely at the root of a spike in teenage pregnancies – some 14,000 new cases according to the Guardian. Some of these pregnancies were due to schools being closed and teenagers being bored, but others were due to desperation.
The Guardian tells the story of a teenage girl called Kadiatu Bangora, Kadiatu went to a family friend when her father was sick and she needed help to buy medicine. “You don’t get something for nothing,” the friend told her. He paid Kadiatu $65 for sleeping with him, but her father died and six weeks later she learned she was pregnant. Teenage pregnancy is seen as shameful in Sierra Leone and although her mother allowed her to stay in the house, Kaditu’s school wouldn't allow her to continue studying. Schools will allow girls back after they have delivered, but that wasn't possible for Kadiatu. "My baby arrived in February but I haven’t gone back to school because we don’t have any money,” she says.
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This Christmas Women and Children First is celebrating a year in which we saved the lives of 116 pregnant women and newborn babies in Malawi. One life lost is one life too many, when something is easily preventable.
We have a simple approach – we give knowledge and a bit of support to set women on the right track. Even the World Health Organisation (WHO) has recognised that our women’s groups save lives. In grand terms: “Implementation of community mobilisation through facilitated participatory learning and action cycles with women’s groups to improve maternal and newborn health is recommended, particularly in rural settings with low access to services”.
Malawi is a country with a weak economy, where 50 per cent of the population survive on less than a $1 a day.
The education system and healthcare facilities have equally suffered. Imagine not having access to a midwife, let alone a doctor when you’re pregnant for the first time and have no idea what to expect.
Women and Children First changes that – it’s like the National Childbirth Trust (NCT), only better.
Do you have elephants on your allotment?
That’s what some of our women’s group members have to deal with…
Adesi gave birth to a healthy baby boy when she was 20 years old and is now expecting a second baby. She has been attending the women’s group for the last three months:
“We had a lot of still births in the community when women delivered at home because the distance is so great to the health facility. So we lobbied for a bicycle ambulance to take us to the facility and we got one. Now we have to contribute monthly for the upkeep and maintenance of the bicycle.”
“We discovered that a lot of the HIV+ members of our community were suffering from malnutrition, so we now advise them about the food groups.
Unfortunately it was not possible to continue with our community vegetable garden as the elephants trampled on it.”
“We encourage women to go to the health centre to give birth and write on the walls of our houses with messages to remind them.”
Adesi is lucky to have the support of her husband and the community she lives in. Women and Children First knows that building up local groups saves lives. Each woman that attends a group is likely to share her learning with a further three women.
Please support our work this Christmas, as one life lost is one life too many.
Diane Fender, Director of Girls' Globe reports on Women and Children First's work in Malawi. This was following the Global Maternal Health Conference in Mexico City this October, where Senior Programmes Manager, Mikey Rosato presented on our successful project with the Ministry Of Health in the Ntcheu district of Malawi.
When women work together, change happens. Regardless of where you live in the world, this is a fact that cannot be denied. Women give life, care for their families, work in markets, trade commodities and help their families grow and thrive. We have all heard that if you invest in a woman, she in turn will invest 90% of what she earns back into her family to improve their livelihood. So why do millions of women – and their babies – continue to face unnecessary and life-threatening risk and danger around the world every day? Women lack access to adequate healthcare facilities, skilled birth attendants and at times are not allowed to receive care from a healthcare facility due to cultural stigmas. Despite notable progress that has been achieved, the fact remains that health disparities for women and newborns continue to be broad and interlinked.